Download Nr 1. A 56-year-old man has been admitted to hospital because of

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Nr 1. A 56-year-old man has been admitted to hospital because of vomiting. The
potassium blood serum is 2.4 mmol/l. The patient is not able to intake any foods.
Indicate the best way to treat hypokalemia:
A. fast intravenous injection of 40 mmol kalium chloride solution.
B. intravenous infusion of kalium chloride diluted in 0.9% saline solution with a speed
of 10 mmol KCl per minute.
C. intravenous infusion of kalium chloride diluted in 0.9% saline solution with short
acting insulin with a speed of 10 mmol KCl per minute.
D. intravenous infusion of kalium chloride in 10% glucose solution with short acting
insulin with a speed of 10 mmol KCl per minute.
E. intravenous infusion of kalium chloride in 10% glucose solution with short acting
insulin with a speed of 10 mmol KCl per hour.
Nr 2. A 87-year-old woman has been admitted to hospital because of dehydration, low
blood pressure and sinus tachycardia. Indicate the best way to treat tachycardia:
A. verapamil intravenous injection. D. metoprolol administered orally.
B. verapamil administered orally.
E. 0.9% sodium chloride intravenous infusion.
C. bisoprolol administered orally.
Nr 3. A 74-year-old woman has been admitted to hospital because of dehydration.
She takes ramipril 10 mg once a day. The serum creatinine concentration is 176
μmol/l. The normal values of serum creatinine concentration have been observed
previously. Blood pressure is 90/60 mmHg. Which of the following treatment is correct?
A. stop ramipril and give thiazide diuretics.
B. stop ramipril and give loop diuretics.
C. stop ramipril and give aldosteron antagonist.
D. stop ramipril and start intravenous 0.9% NaCl infusion.
E. continue ramipril and start intravenous 0.9% NaCl infusion.
Nr 4. Which of the following antibiotics should be used as empiric first-line treatment
in a 30-year-old woman with bacterial urinary tract infection?
A. third-generation cephalosporin.
D. antibiotics from fluoroquinolone group.
B. second-generation cephalosporin.
E. antibiotics from aminoglycoside group.
C. first-generation cephalosporin.
Nr 5. 65-year-old man has been admitted to hospital because of nose bleeding. The
patient takes acenocoumarol 3 mg once a day because of permanent atrial fibrillation.
Indicate the best medical test to confirm the overdosing of acenocoumarol:
A. bleeding time.
B. prothrombin time.
C. vitamin K concentration in blood plasma.
D. factor VIII concentration in blood plasma.
E. activated partial thromboplastin time.
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Nr 6. Chronic Helicobacter pylori infection can lead to the development of:
1) gastric ulcer;
4) Barrett oesophagus;
2) vitamin B12 deficiency;
5) gastric MALT lymphoma.
3) bacterial overgrowth syndrome;
The correct answer is:
A. all the above. B. 1,2,3,5. C. 1,2,4.
D. 1,2,5.
E. 1,2,4,5.
Nr 7. The factors that trigger jaundice in the most common congenital
hyperbilirubinemia, i.e. Gilbert's syndrome, include:
1) stress;
4) alcohol consumption;
2) physical exercise;
5) febrile illness;
3) starvation;
6) premenstrual period in women.
The correct answer is:
A. 1,2,3,5.
B. 2,3,5,6.
C. all the above.
D. 1,2,4,5,6.
E. 1,2,3,4,5.
Nr 8. A 50-year-old male with chronic fatigue, itchy skin, weight loss, and a history of
ulcerative colitis. Physical examination reveals the yellowing of the skin and mucous
membranes, as well as numerous scratches on the skin; laboratory studies: increased
ALP and GGT (2-10 fold), AST and ALT (2-4 fold). The most likely diagnosis is:
A. primary sclerosing cholangitis.
B. autoimmune hepatitis.
C. primary biliary cirrhosis.
D. intrahepatic cholestasis.
E. chronic cholangitis.
Nr 9. Contraindications to the use of ursodeoxycholic acid (UDCA) in the treatment
of cholecystolithiasis are:
1) pigment stones;
4) multiple stones;
2) calcium stones;
5) pregnancy;
3) deposits with a diameter exceeding 15 mm;
6) obesity.
The correct answer is:
A. 1,2,3,5. B. 4,5,6. C. all the above.
D. none of the above.
E. only 5.
Nr 10. The common causes of acute pancreatitis are:
1) stones in the gallbladder and biliary tract;
2) alcohol;
3) endoscopic retrograde cholangiopancreatography;
4) some medications;
5) abdominal trauma;
6) bacterial infections.
The correct answer is:
A. 1,2,3.
B. 1,2,6.
C. 2,3,6.
D. 3,5,6.
E. all the above.
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Nr 11. The complications of chronic pancreatitis include:
1) pancreatic cancer;
2) true pancreatic cyst;
3) pseudoaneurysm of the vessels in the vicinity of the pancreas;
4) narrowing or obstruction of the common bile duct or duodenum;
5) pancreatic ascites.
The correct answer is:
A. 1,2,3,4.
B. 1,2,4,5.
C. 1,2,3,5.
D. 1,3,4,5.
E. 2,3,4,5.
Nr 12. Risk factors for pancreatic cancer include:
1) smoking;
2) chronic pancreatitis;
3) acute pancreatitis;
The correct answer is:
A. all the above.
B. 1,3,5.
4) genetic predisposition;
5) large intake of fat and meat;
6) diabetes.
C. 1,4,5,6.
D. 1,2,3,4,5.
E. 1,2,4,5,6.
Nr 13. Hematuria is not a feature of:
A. renal carcinoma.
B. interstitial nephritis.
C. hypocalciuria.
D. renal papillary necrosis.
E. glomerulonephritis.
Nr 14. Chronic hepatitis C infection:
A. has renal manifestation in up to 30% of patients.
B. is a cause of mixed cryoglobulinemia.
C. may cause nephritic syndrome.
D. all the above statements are true.
E. B and C are true.
Nr 15. Pulmonary-renal syndrome is typical of:
A. Goodpasture syndrome.
B. ANCA-associated small-vessel vasculitis.
C. lupus erythematosus.
D. cryoglobulinemia.
E. all the above.
Nr 16. Which of the following concerning IgA nephropathy is false?
A. classically is characterized by episodic hematuria.
B. is associated with the deposition of IgA in the Bowman’s capsule.
C. is one of the most common forms of glomerulonephritis worldwide.
D. should be distinguished from Henoch-Schőnlein purpura.
E. may be familial.
Nr 17. Which of the following is not a risk factor for diabetic nephropathy?
A. hyperglycemia.
B. normal blood pressure.
C. dyslipidemia.
D. smoking.
E. family history of diabetic nephropathy.
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Nr 18. Which of the following concerning cholesterol emboli is false?
A. is caused by the release of plague cholesterol crystals into the circulation.
B. most commonly follows endovascular procedure involving large arteries, such as
aorta.
C. should be treated with anticoagulants.
D. may manifest itself through cerebral transient ischemic attacks.
E. often livedo reticularis in the lower extremities is present.
Nr 19. Hypertensive nephropathy:
A. is arteriolosclerosis, chronic nephrosclerosis and interstitial fibrosis of the kidneys.
B. is 5 times more common in white race.
C. develops in most patients with hypertension.
D. should be confirmed by renal biopsy.
E. is characterized by nephrotic syndrome.
Nr 20. Impaired renal blood flow may be caused by:
A. non-steroidal anti-inflammatory drugs.
B. ACE inhibitors.
C. cyclosporine.
D. angiotensin receptor blockers.
E. all answers are correct.
Nr 21. Acute kidney injury:
A. is associated with significantly increased mortality.
B. may progress to end-stage renal disease in up to 10% of patients.
C. complete recovery is possible in some patients.
D. all the above are true.
E. A and C are true.
Nr 22. A 52-year-old patient with a history of hypertension and hyperlipidemia was
attended in the Emergency Room due to intense chest pain radiating to his back,
accompanied by dyspnoea. On physical examination asymmetry in radial pulse and a
diastolic murmur were found. Which is the most probable diagnosis?
A. acute mitral insufficiency.
D. pulmonary embolism.
B. myocardial infarction.
E. pneumothorax.
C. aortic dissecting aneurysm.
Nr 23. A 75-year-old female patient with a two month history of stenokardia,
palpitations and dizziness. Physical examination reveals a crescendo-decrescendo
systolic murmur at the base of the heart radiating to the neck. Which is the most
probable valvular heart disease?
A. mitral stenosis.
D. aortic regurgitation.
B. mitral regurgitation.
E. tricuspid regurgitation.
C. aortic stenosis.
Nr 24. Which of the following heart diseases can be treated with cardiac
resynchronization therapy (CRT)?
A. acute coronary syndrome.
B. hypertension.
C. chronic heart failure.
D. atrial fibrillation.
E. aortic stenosis.
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Nr 25. Which of the following is the possible complication of coronary angiography?
A. cardiac arrest.
B. anaphylactic shock.
C. contrast induced nephropathy.
D. haemotoma at the puncture site.
E. all the above.
Nr 26. Which is the best laboratory marker reflecting heart failure advancement?
A. CKMB.
B. troponin.
C. proBNP.
D. D-dimer.
E. haemoglobin.
Nr 27. Which of the following is not associated with right-sided heart failure?
A. peripheral oedemas.
B. basal crepitations in the lungs.
C. jugular vein distention.
D. positive hepatojugular reflex.
E. ascites.
Nr 28. Digoxin overdose may be associated with the following side effects:
A. paroxysmal atrial tachycardia with block.
B. increase in ventricular arrhythmia.
C. sinus bradycardia.
D. second degree atrio-ventricular
block.
E. all of the above.
Nr 29. Atrial fibrillation may be complicated with:
A. aggravation of heart failure symptoms.
B. stroke.
C. decrease in the quality of life.
D. aggravation of stenocardia.
E. all of the above.
Nr 30. The photosensitivity is typical of:
A. systemic sclerosis.
B. rheumatoid arthritis.
C. systemic lupus erythematosus.
D. polymyositis.
E. none of the above.
Nr 31. Ketoprofen is a nonsteroidal anti-inflammatory drug given as a therapy for
various types of arthritides. The maximal daily dose is:
A. 50 mg.
D. 1000 mg.
B. 100 mg.
E. ketoprofen is not a nonsteroidal anti-inflammatory drug.
C. 200 mg.
Nr 32. A 55-year-old obese male woke up in the early morning with a strong pain and
the swelling of the right toe. The skin in this region was red and warm. In laboratory
testing: uric acid 10 mg/dl. The reasonable therapeutic option in the presented acute
attack of the underlying disease is:
A. colchicine 1 mg each 6h during the first day.
D. tramadol.
B. acetylsalicylic acid 75 mg/d.
E. A and/or B are true.
C. acetaminophen.
Nr 33. Which of the following is not a risk factor for osteoporosis?
A. increased coffee intake.
B. advanced age.
C. obesity.
D. long-term steroid therapy.
E. vitamin D deficiency.
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Nr 34. A rheumatoid factor may be present in the serum of patients with:
A. rheumatoid arthritis.
B. viral hepatitis.
C. borreliosis.
D. in the normal elderly.
E. all the above.
Nr 35. A 65-year-old obese female is complaining about stiffness occurring after
prolonged rest (sitting or lying), pain in the joints of both hands and knees. In physical
examination: Heberden’s nodules, genu varum. In X-ray imaging: osteophytes. In
laboratory testing: ESR 12 mm/h. In the presented case the following should be diagnosed:
A. osteoarthritis.
D. systemic lupus erythematosus.
B. rheumatoid arthritis.
E. Paget disease.
C. polymyalgia rheumatica.
Nr 36. Which of the following body regions is/are typically involved in polymyositis?
A. hands. B. abdomen. C. pectoral and /or pelvic girdle.
D. face.
E. all the above.
Nr 37. Dyspnoea, dry cough and decreased exercise tolerance occurring in the
course of systemic sclerosis are related to:
A. interstitial lung disease.
D. bronchial asthma.
B. pulmonary hypertension.
E. A and B are true.
C. emphysema.
Nr 38. Which of the following autoantibodies are the most specific ones to systemic
lupus erythematosus (SLE)?
A. anti-dsDNA.
B. anti-Scl-70.
C. anti-Jo1.
D. anti-CCP.
E. anti-SS-A, anti-SS-B.
Nr 39. Which of the following is the first line disease modifying therapy in rheumatoid
arthritis?
A. glucocorticosteroids.
D. methotrexate.
B. nonsteroidal anti-inflammatory drugs (NSAIDs). E. biological drugs with anticytoC. acetaminophen.
kine activity (anti-TNFα).
Nr 40. Immunosuppressive treatment after renal transplantation significantly increases a
risk of cancer development. In renal transplant recipients the most common neoplasms
are:
A. liver tumors. B. skin tumors. C. breast cancers. D. colon cancers. E. leukemia.
Nr 41. The indications for blood pressure measurements in children aged <3 years are:
1) complications of perinatal period: prematurity, low weight at birth;
2) recurrent UTI/abnormalities of urinary tract;
3) malignancies;
4) post organ transplantation status;
5) diseases connected with hypertension.
The correct answer is:
A. 1,2.
B. 1,2,3.
C. 3,4.
D. all the above. E. only 5.
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Nr 42. Which of the following tests GP should perform in a child with elevated arterial
blood pressure?
1) diagnose arterial hypertension in the course of three visits;
2) confirm the diagnosis with ABPM (ambulatory blood pressure monitoring);
3) classify the hypertension;
4) make a preliminary assessment of organ damage and/or metabolic
disorders;
5) refer to hospital.
The correct answer is:
A. 1,2,5.
B. 1,3,4.
C. 1,2,3,4.
D. only 5.
E. all the above.
Nr 43. In a child with paroxysmal arterial hypertension one should perform:
1) kidney ultrasound imaging;
2) abdomen CT or MRI;
3) measurement of noradrenaline and adrenaline metabolites;
4) adrenal scintigraphy with metaiodobenzylguanidine (MIBG);
5) echocardiography.
The correct answer is:
A. 1,2,3.
B. 2,3.
C. 3,4.
D. only 5.
E. all the above.
Nr 44. A tuberculosis risk after M. tuberculosis infection in children without immune
deficiencies is the highest in the following age group:
A. < 12 months. B. 12-24 months. C. 2-4 years. D. 5-10 years.
E. > 10 years.
Nr 45. The physiological process of teething is regulated by genetic, hormonal and
environmental factors. Locally, the redness and oedema of the gums is seen. Which of
the following are the most common systemic symptoms accompanying teething?
1) excessive drooling and biting hard objects;
4) sleeping disorders;
2) decreased appetite, gastrointestinal disorders; 5) fever >39 °C.
3) subfebrile body temperature;
The correct answer is:
A. 1,2,3.
B. 1,2,3,4.
C. 1,4,5.
D. all the above.
E. 2,5.
Nr 46. The beginning of neonatal lung ventilation causes:
A. decreased PaCO2 and increased PaO2 and pH.
B. increased PaCO2, PaO2 and pH.
C. increased PaCO2 and decreased PaO2 and pH.
D. decreased PaCO2, PaO2 and pH.
E. decreased PaCO2 and pH and increased PaO2.
Nr 47. Detailed physical examination should be carried out by a pediatrician
(neonatologist) within the first:
A. 2 hours after birth.
B. 6 hours after birth.
C. 8 hours after birth.
D. 12 hours after birth.
E. 24 hours after birth.
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Nr 48. In older children the most common causes of vomiting, which require surgical
intervention are:
A. appendicitis, peritonitis, obstruction from adhesions.
B. pyloric stenosis, peritonitis, necrotizing enterocolitis.
C. intussusception, gastroesophageal reflux, obstruction.
D. obstruction from adhesions, necrotizing enterocolitis, Hirschsprung disease.
E. intestinal malrotation, Hirschsprung disease, peritonitis.
Nr 49. Babinski’s reflex – when the sole of the foot is stroked the big toe moves
toward the top of the foot and the other toes fan out – may physiologically occur in
children:
A. up to 6 months old.
D. up to 24 months old.
B. up to 12 months old.
E. it cannot occur.
C. up to 18 months old.
Nr 50. Tetralogy of Fallot constitutes about 3-5% of congenital heart defects and is
characterized by:
A. ventricular septal defect (VSD), narrowing of the right ventricular outflow tract, translocation of the aorta above the ventricular septal defect, right ventricular
hypertrophy.
B. atrial septal defect (ASD), narrowing of the left ventricular outflow tract, translocation of the aorta above the ventricular septal defect, right ventricular hypertrophy.
C. atrial septal defect (ASD), left ventricular hypertrophy.
D. ventricular septal defect (VSD), translocation of the aorta above the ventricular
septal defect, left ventricular hypertrophy.
E. ventricular septal defect (VSD), narrowing of the left ventricular outflow tract, translocation of the aorta above the ventricular septal defect, left ventricular hypertrophy.
Nr 51. Scarlet fever is an acute infectious disease caused by group A Streptococci. It
can cause the following complications:
1) lymphadenitis;
4) arthritis;
2) otitis media;
5) myocarditis and endocarditis.
3) nephritis;
The correct answer is:
A. 1,2,3.
B. 1,2,4.
C. 1,2,4,5.
D. 2,4,5.
E. all the above.
Nr 52. Which of the following is a commonly used scale of gestational age
assessment?
A. Child.
B. Tanner.
C. Ballard.
D. Pirquet.
E. Glasgow.
Nr 53. Which of the following manoeuvres is performed in a physical examination on
infants to screen for the development of the hips?
A. Lasegue and Moro.
D. Ortolani and Lasegue.
B. Barlow and Ortolani.
E. Moro and Barlow.
C. Barlow and Lasegue.
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Nr 54. Grott’s palpation method is performed to examine:
A. pancreas.
B. stomach.
C. intestines.
D. liver.
E. spleen.
Nr 55. Which of the following is an absolute contraindication to parenteral nutrition in
children and adolescents?
A. necrotizing enterocolitis.
B. Hirschsprung’s disease.
C. perinatal intestinal perforation.
D. shock.
E. immunological enterocolitis.
Nr 56. A 13-year-old girl with abdominal pain with no specific location (mostly in the
umbilical region), sudden beginning, crampy character and short-lasting (up to 10
minutes). The abdominal pain is increasing during a rest and decreasing during
exercise. The most probable diagnosis is:
A. psychogenic abdominal pain.
D. organic abdominal pain.
B. somatic abdominal pain.
E. all the answers are false.
C. functional abdominal pain.
Nr 57. A 2-month-old female infant was admitted to hospital due to defecation disorders
(alternating constipation and diarrhoea) and a loss of appetite. In medical examination
abdominal distension and the empty rectal ampulla in a per rectum study were noticed.
The contrast enema showed a stricture in the distal part of the colon with a widening
above. In histopathological study - a lack of ganglion cells in the rectum. The diagnosis is:
A. functional constipation.
D. ulcerative colitis.
B. Hirschsprung’s disease.
E. intestinal colic.
C. irritable bowel syndrome.
Nr 58. Which of the following should be applied in the medical management of
vesicoureteral reflux?
A. penicillin.
B. amoxicillin.
C. amoxicillin with clavulanic acid.
D. nifedipine.
E. furazidin.
Nr 59. Which of the following should be applied in the first line treatment of febrile
convulsions in a 7-year-old boy?
A. valproic acid. B. clonazepam. C. topiramate.
D. diazepam.
E. vigabatrin.
Nr 60. In which of the following is a malformation of the brain which consists of a
downward displacement of the cerebellar tonsils through the foramen magnum?
A. Dandy’ego-Walker.
D. Peutz-Jeghers.
B. Prader and Wille.
E. Arnold-Chiari.
C. Angelman.
Nr 61. The characteristic symptoms of sepsis in newborns are:
1) fever;
2) hypothermia;
3) respiratory disorders;
The correct answer is:
A. 1,3.
B. 1,3,4.
4) jaundice;
5) hepatomegaly.
C. 2,3.
D. 1,3,5.
E. all the above.
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Nr 62. The diagnosis of juvenile idiopathic arthritis is excluded by:
A. lack of rheumatoid factor (RF).
B. lack of anti-citrullinated protein antibodies (anti-CCP).
C. presence of antinuclear antibodies (ANA).
D. inflammation of a single joint.
E. none of the above.
Nr 63. In the severe course of systemic juvenile idiopathic arthritis many symptoms
which are present in proliferative diseases could be observed. What are the common
symptoms that could be observed in either case?
A. lymphadenopathy.
D. arthritis.
B. hepatosplenomegaly.
E. all the above.
C. fever.
Nr 64. What are the side effects of chronic glucocorticosteroids therapy?
1) hypertension;
2) osteoporosis;
3) gastritis;
The correct answer is:
A. 1,5.
B. 1,2,3,4.
4) diabetes;
5) hyperkalemia.
C. 2,3.
D. 2,3,5.
E. all the above.
Nr 65. Scarlet fever is an infectious disease caused by the group A Streptococci
producing erythrogenic toxin. Which of the following symptoms are typical of this
disease:
1) face appears flushed but with the presence of circumoral pallor;
2) presence of gray-white, sand grain-seized dots on buccal mucosa (Koplik
spots);
3) rash that appears unsymmetrically every couple of hours, initially as small
red papules and rapidly progresses to non-umbilicated oval vesicles;
4) areas of more intense erythema are noted in skin folds (Pastia lines);
5) red strawberry tongue;
6) palm and finger skin may peel off in thick patches 2 weeks after the relief of
rashes.
The correct answer is:
A. 1,2,4,5,6.
B. 1,4,5,6.
C. 1,2,4,5.
D. 1,3,4,5,6.
E. all the above.
Nr 66. Unintentional ingestions are one of the most common life-threatening condition
in the 1-5-year-old age group of patients. Which of the following is unproper method of
initial therapy in the case of a patient who is conscious and without respiratory and
heart rhythm abnormalities?
A. in the case of drug ingestion a rapid gastric emptying should be provoked.
B. in the case of a lack of emetic reaction after provocation one should perform a
gastric lavage.
C. gastric lavage should be the routine management of detergent ingestions.
D. in the case of corrosive substance ingestion one should not provoke emetic
reaction. The proper management is to give 2-3 egg whites in 100 ml of water.
E. in the case of toxic plant ingestion one should provoke emetic reaction.
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Nr 67. The Apgar Score assessment includes 5 clinical parameters excluding:
A. GIT function (meconium presence).
B. cardiac function (heart rate).
C. respiration.
D. color of the body.
E. muscle tone.
Nr 68. Which of the following cardiac anomalies is/are the most characteristic of
Turner syndrome:
A. pulmonary stenosis, VSD.
B. bicuspid aortic valve and coarctation of the aorta.
C. hypoplastic left heart syndrome (HLHS).
D. tetralogy of Fallot.
E. AVSD.
Nr 69. Which of the following medications are administered in the case of bleeding
caused by oral anticoagulants overdose?
A. fresh frozen plasma preparations.
B. platelets preparations.
C. human recombinant factor VII.
D. A and C.
E. A, B and C.
Nr 70. The plain abdominal film should be ordered to confirm:
A. gastrointestinal obstruction.
B. gastrointestinal perforation.
C. cholecystolithiasis.
D. A and B.
E. A, B and C.
Nr 71. Acute cholangitis occurs as a result of bile infection induced by impaired bile
duct patency which in turn is caused by:
A. choledocholithiasis.
B. bile duct neoplasms.
C. iatrogenic biliary damage.
D. parasites.
E. all the above.
Nr 72. Which of the following are true?
1) alcohol ingestion is one of the most frequent causes of acute pancreatitis;
2) chronic pancreatitis is related to the increased risk of pancreatic cancer;
3) about 50% of cases of acute pancreatitis is severe;
4) Whipple surgery procedure is the basic surgical treatment of acute
necrotizing pancreatitis.
The correct answer is:
A. 1,2.
B. 1,2,3.
C. all the above.
D. 1,3.
E. 1,4.
Nr 73. Is cholecystectomy indicated in the treatment of asymptomatic patients with a
sonographic picture of normal thickness of the gallbladder wall and multiple gallbladder
stones?
1) yes, on the patient’s explicit request;
2) never;
3) yes, in patients awaiting cardiac surgery;
4) yes, in patients requiring immunosuppressive treatment.
The correct answer is:
A. only 2.
B. 1,3.
C. 1,3,4.
D. 3,4.
E. only 1.
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Nr 74. In which of the following situations percutaneus endoscopic gastrostomy
(PEG) would be inappropriate?
A. in the case of obstructing esophageal tumor.
B. in the case of obstructing gastric cardia tumor.
C. in the case of obstructing gastric pylorus tumor.
D. A and B.
E. A, B and C.
Nr 75. A 70-year-old female comes to the ER because of abdominal pain and
distension lasting 3 days, and constipation (last stool 4 days ago). In anamnesis there
are no abdominal surgeries. For the last 2 months she has lost approx. 5 kg. What is
the proper management?
1) laparotomy as soon as possible due to mechanical obstruction;
2) radiological diagnostics (plain abdominal film) for mechanical small bowel
obstruction caused by adhesions, as the most probable cause of the
complaints;
3) radiological diagnostics (plain abdominal film) for mechanical large bowel
obstruction caused by cancer, as the most probable cause of the
complaints;
4) after confirming mechanical obstruction on the plain abdominal film – urgent
laparotomy;
5) after confirming mechanical large bowel obstruction on the plain abdominal
film – contrast enema in order to determine the level of obstruction and
whether it is partial or complete. Decision concerning a mode of the
operation depends on the result of the contrast enema.
The correct answer is:
A. only 1.
B. 3,5.
C. 2,4.
D. 2,5.
E. none of the above.
Nr 76. Which of the following properly characterize the most probable causes of the
condition following head trauma:
1) if a patient was temporarily unconscious, suffered head trauma and at the
same time urinated, then the most probable cause of his/her condition would
be brain stroke;
2) if a patient was temporarily unconscious, suffered head trauma and at the
same time passed tarry stool, then the most probable cause of his/her
condition is gastrointestinal bleeding;
3) if a patient suffered head trauma, was unconscious for a moment and does
not remember circumstances of the event, then it is a typical picture of brain
concussion;
4) if a patient was temporarily unconscious, suffered head trauma and presents
with anisocoria, it is most probably the result of epileptic seizure;
5) if a patient suffered head trauma, is unconscious, presents with anisocoria
and bradycardia, then it is most probably caused by intracranial hematoma.
The correct answer is:
A. 1,2,3.
B. 1,4,5.
C. 2,4,5.
D. 2,3,4.
E. 2,3,5.
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Nr 77. Which of the following sentences concerning gastric cancer is true?
1) early cancer, when the infiltration does not exceed the mucosa, with tumor
diameter up to 2 cm can be treated with endoscopy (mucosectomy);
2) advanced cancer is treated surgically with total gastrectomy, regardless of
the location of the tumor;
3) early cancer typically is treated surgically with partial gastrectomy and
regional lymph nodes resection;
4) adjuvant chemotherapy is as important part of the treatment as surgery;
5) preoperative radiotherapy is a standard procedure before surgical treatment
of advanced gastric cancer.
The correct answer is:
A. 1,2,4.
B. 1,2,5.
C. 1,3.
D. 3,5.
E. 1,4.
Nr 78. The best way to differentially diagnose GI bleeding from esophageal varices
and GI bleeding from gastric or duodenal ulcer is:
A. nature of vomit: the presence of bright red blood or clots (varices) or vomit that
looks like coffee grounds (ulcer).
B. characteristics of stool: bloody stool (varices) or tarry stools (ulcer).
C. patient’s general condition: severe with hemodynamic instability (varices) or good,
with no hemodynamic changes (ulcers).
D. anamnesis and physical examination: liver cirrhosis in anamnesis and clinical
symptoms of cirrhosis on physical examination (varices).
E. intensity of bleeding: massive bleeding (varices) or small bleeding (ulcer).
Nr 79. Which of the following concerning abdominal hernia incarceration are true?:
1) inguinal hernia is most often incarcerated;
2) in some cases only the intestine wall is incarcerated;
3) incarcerated hernia always leads to mechanical bowel obstruction;
4) incarceration occurs mostly at night during sleep.
The correct answer is:
A. all the above.
B. 1,2,4.
C. 2,4.
D. 1,2.
E. 1,2,3.
Nr 80. A pathologic fracture is when a bone fails in an area weakened by pre-existing
disease. The causes do not include:
A. injury to an old fracture site.
D. metabolic and systemic diseases.
B. primary bone tumors or metastatic lesions. E. inborn diseases.
C. bone infection.
Nr 81. A patient comes to the surgery ER because of severe pain in the anal region
lasting for the last 24 hours. On physical exam, to the left of the anus there is a
fluctuant mass covered with red and palpable tender skin. In anamnesis: there are no
concomitant diseases. Which of the following abscesses according to Corman’s
classification is the most probable in this patient?
A. intersphincteric abscess.
D. abscess in rectal marginal clot.
B. ischioanal abscess.
E. abscesses mentioned in A, B and C are equally
C. supralevator abscess.
frequent.
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Nr 82. Which of the following are the correct approaches to an asymptomatic,
incidentally found adrenal tumor of 5 cm in diameter:
1) only laparoscopic surgery;
2) surgery should be dependent on hormonal evaluation;
3) laparoscopic or traditional surgery;
4) approach should not be dependent on tumor size changes in subsequent
imaging studies;
5) start pharmacological treatment before the surgery.
The correct answer is:
A. 1,2.
B. 3,4.
C. 1,5.
D. 2,4.
E. 3,5.
Nr 83. The intestine wall undergoes necrosis as a result of:
1) hernia incarceration;
2) portal hypertension;
3) bowel strangulation around peritoneal adhesions;
4) mesentery artery embolism;
5) diverticula of small intestine.
The correct answer is:
A. 1,2,3.
B. 2,3,4.
C. 1,3,5.
D. 1,3,4.
E. 1,2,4.
Nr 84. Which of the following concerning acute appendicitis are true?
1) should be operated only laparoscopically;
2) does not occur over the age of 50;
3) ultrasound imaging is helpful in diagnosis;
4) is a result of Clostridium difficile infection;
5) begins with an epigastric pain migrating to the right iliac fossa.
The correct answer is:
A. 3,5.
B. 2,4.
C. 3,4.
D. 1,5.
E. 2,5.
Nr 85. Which of the following are the symptoms of mechanical bowel obstruction:
1) elevated white blood count;
2) wave-like abdominal pain;
3) retention of gases and constipation;
The correct answer is:
A. 2,3.
B. 2,4.
C. 3,4.
4) hyperkalemia;
5) bradycardia.
D. 1,3.
E. 2,5.
Nr 86. Mechanical jaundice and the enlarged gallbladder are typical symptoms of:
1) cancer of the pancreatic corpus; 4) cholecystolithiasis;
2) pancreas head cancer;
5) carcinoma of the ampulla of Vater.
3) hepatocellular carcinoma;
The correct answer is:
A. 1,2.
B. 2,3.
C. 4,5.
D. 2,5.
E. 1,5.
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Nr 87. In the treatment of perianal fistulas in Lesniowski-Crohn’s disease all of the
following are used except:
A. fistulotomy and drainage.
B. steroids.
C. infliximab and adalimumab.
D. EUA (examination under anaesthesia) and
placing of non-cutting loose setons.
E. fistulectomy.
Nr 88. The intestinal obstruction most commonly results from:
A. gallstone disease.
B. inguinal hernia incarceration.
C. big polyp of small intestine.
D. colon cancer.
E. small intestine torsion.
Nr 89. Which of the following methods is not used in the surgical treatment of the
hemorrhoidal disease?
A. DGHAL.
B. Stretta.
C. Milligan-Morgan.
D. Longo.
E. Ferguson.
Nr 90. The knowledge of the Calot’s triangle topography is necessary in the surgical
treatment of:
A. adrenal tumor.
B. pancreatic tumor.
C. gastric ulcer.
D. Hashimoto disease.
E. gallstone disease.
Nr 91. TEM (Transanal Endoscopic Microsurgery) is the surgical technique useful in:
A. miniinvasive treatment of advanced anal tumors.
B. treatment of the low grade (poorly differentiated) sigmoid cancer.
C. miniinvasive treatment of rectal tumors.
D. laparoscopic treatment of rectal cancer.
E. C and D are correct.
Nr 92. Which of the following concerning post-thrombotic syndrome are true?
1) develops as a result of superficial vein thrombosis;
2) develops as a result of deep vein thrombosis;
3) causes trophic skin changes near the medial ankle;
4) causes trophic skin changes near the lateral ankle;
5) venous hypertension is the cause of trophic skin changes;
6) perforating vein ligations do not prevent recurrent ulcerations.
The correct answer is:
A. 1,3,5.
B. 1,4,6.
C. 2,3,5.
D. 2,4,5.
E. 2,4,6.
Nr 93. Which of the following concerning erysipelas are true?
1) it is an acute skin inflammation caused by Streptococci;
2) it is an acute skin inflammation caused by Staphylococci;
3) it is characterized by high fever (up to 40 °C);
4) it is characterized by fever that does not exceed 38 °C;
5) systemic symptoms are characteristic;
6) only local symptoms are characteristic.
The correct answer is:
A. 1,3,5.
B. 1,3,6.
C. 1,4,6.
D. 2,3,5.
E. 2,4,6.
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Nr 94. The most common complication of the treatment of the humerus shaft fractures is:
A. ulnar nerve palsy.
B. median nerve palsy.
C. radial nerve palsy.
D. brachial artery damage.
E. post-traumatic algodystrophy.
Nr 95. Which of the following are the complications of fractured bone union?
1) mal-union of fractured bone;
2) osteitis;
3) contractures in neighbouring joints;
4) delayed union of the fractured bone;
5) pseudoarthrosis.
The correct answer is:
A. 1,2,5.
B. 1,4,5.
C. 2,3,5.
D. 2,4,5.
E. 3,4,5.
Nr 96. The triad of symptoms of ectopic pregnancy localized in the salpinx includes:
1) temperature above 38.3°C;
4) watery vaginal discharges;
2) period of amenorrhoea;
5) vaginal bleeding.
3) abdominal pain;
The correct answer is:
A. 1,3,5.
B. 2,3,5.
C. 2,3,4.
D. 3,4,5.
E. 1,2,5.
Nr 97. Which of the following is the most likely disease in patient with temperature
above 38°C, pain with movement of the cervix, tenderness of the uterus and/or ovaries
on palpation, and with muco-purulent vaginal discharge?
A. pelvic inflammatory disease.
D. pelvic endometriosis.
B. ectopic pregnancy.
E. rupture of ovarian tumor.
C. diverticulosis.
Nr 98. The most common unrelated to pregnancy cause of acute abdomen during
pregnancy is:
A. intestinal obstruction.
B. acute cholecystitis.
C. acute appendicitis.
D. duodenal ulcer.
E. rupture of liver.
Nr 99. Generally, anemia in pregnant women can best be defined as:
A. lack of iron stores.
B. genetic defect.
C. folic acid deficiency.
D. hemoglobin below 11 g/dL.
E. low blood volume.
Nr 100. Which of the following is released from the Graafian follicle during ovulation?
A. primary oocyte.
D. secondary oocyte and first polar body.
B. primary oocyte and first polar body. E. secondary oocyte and second polar body.
C. secondary oocyte.
Now, take the other answer ticket and mark the answers
to questions 101 - 200.
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Nr 101. During which of the following conditions would serum prolactin reach the
highest level?
A. sleep.
B. ovulation.
C. parturition.
D. menopause.
E. orgasm.
Nr 102. Tyrosine is an essential amino acid for the biosynthesis of:
A. dopamine.
B. GnRH.
C. dynorphin.
D. vasopressin.
E. prostaglandins.
Nr 103. A 76-year-old obese patient reported to a doctor because of slight vaginal
bleeding for two weeks. The last menstruation occurred 22 years ago. She never was
pregnant, did not take oral contraceptives nor hormonal replacement therapy. She
suffers from diabetes mellitus for 20 years and takes oral hypoglycemic drugs. The
best way to find the cause of the bleeding is:
A. transvaginal ultrasound examination.
B. to calm the patient and to plan a control visit in 2 weeks.
C. cytological examination.
D. colposcopy and cervical biopsy.
E. dilation and curettage with histopathological examination of the removed tissue.
Nr 104. The diagonal conjugate can be measured clinically to help predict ability to
deliver a baby vaginally. In the normal pelvis it should be at least:
A. 6 cm.
B. 8.5 cm.
C. 10 cm.
D. 12 cm.
E. 14 cm.
Nr 105. The diagnostic criteria of antiphospholipide syndrome include the following
except:
A. proteinuria.
B. thrombosis.
C. recurrent pregnancy loss.
D. presence of anticardiolipin antibodies.
E. presence of lupus anticoagulant.
Nr 106. Hyperemesis gravidarum is frequently accompanied by:
A. diabetes.
B. Cushing syndrome.
C. hypoparathyroidism.
D. hypothyroidism.
E. hyperthyroidism.
Nr 107. Which of the following is not associated with an increased risk of ectopic
pregnancy?
A. previous pelvic inflammatory disease.
B. previous Fallopian tube surgery.
C. in vitro fertilization.
D. oral contraception.
E. salpingitis.
Nr 108. Blood pressure ≥140/90 mmHg after 20. weeks of gestation and proteinuria ≥
300 mg/24 hours represent the diagnostic criteria of:
A. gestational hypertension.
D. chronic hypertension.
B. preeclampsia.
E. none of the above.
C. eclampsia.
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Nr 109. Which agent is used to stimulate the development of the fetal lungs in the
case of threatened preterm labor?
A. betamethasone.
B. fenoterole.
C. magnesium sulphate.
D. prednisone.
E. nifedipine.
Nr 110. The most frequent mechanism of placental delivery is:
A. Duncan mechanism.
B. Schultze mechanism.
C. Bracht mechanism.
D. DeLee mechanism.
E. none of the above.
Nr 111. The intercristal distance in a woman should be:
A. 20-21 cm.
B. 23-24 cm.
C. 25-26 cm.
D. 28-29 cm.
E. 30-31 cm.
Nr 112. Differential diagnosis of hyperemesis in pregnancy should take into
consideration:
1) enteritis and gastritis;
2) cholecystitis;
3) acute pancreatitis;
The correct answer is:
A. 1,3,5.
B. all the above.
4) primary hyperparathyroidism;
5) primary hypoparathyroidism.
C. 2,3,4.
D. 2,3,5.
E. 1,3,4.
Nr 113. The following conditions are the risk factors for ectopic pregnancy:
1) infection with Chlamydia trachomatis;
2) fallopian tube surgery in anamnesis;
3) pelvic inflammatory disease in anamnesis;
4) presence of IUD in the uterus;
5) candidiasis of the vagina and the uterine cervix.
The correct answer is:
A. all the above.
B. 1,3,5.
C. 2,3,4.
D. 2,3,4,5.
E. 1,2,3,4.
Nr 114. Vitamin A deficiency in pregnancy may cause in the fetus:
1) growth disorders;
4) excessive adipose
2) congenital xerophthalmia;
tissue;
3) central nervous system malformation;
5) prematurity.
The correct answer is:
A. all the above. B. 1,3,5.
C. 2,3,4.
D. 1,2,3,5.
E. 1,3,4.
Nr 115. The following symptoms are necessary to diagnose pregnancy:
1) abdominal girth increase;
2) hearing of fetal cardiac activity;
3) fetal visualization during an ultrasound examination;
4) increased level of human chorionic gonadotropin;
5) increased level of human placental lactogen.
The correct answer is:
A. all the above.
B. 1,2,3,4.
C. 2,3,4.
D. 2,3,4,5.
E. 2,3.
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Nr 116. Delayed puberty in girls or arrest of sexual development in women may be
caused by:
A. endometriosis.
B. anorexia nervosa.
C. nocturia.
D. ovarian tumour producing estrogens.
E. polycystic ovary syndrome.
Nr 117. A 17-year-old girl reported to a medical office because of a pain in her lower
abdomen. Despite normal tertiary sexual characteristics she never menstruated. Which
of following should be considered as a possible diagnosis?
A. unicornuate uterus.
D. rudimentary horn of the uterus.
B. uterus didelphys.
E. congenital absence of the cervix.
C. septate uterus.
Nr 118. Which of the following diseases are caused by viruses:
1) syphilis;
2) molluscum contagiosum;
3) Herpes genitalis;
The correct answer is:
A. 1,2.
B. 2,3.
C. 3,4.
4) gonorrhea;
5) trichomoniasis;
6) chancroid.
D. 5,6.
E. 3,6.
Nr 119. Which of the following tumours is observed in Lynch II syndrome?
A. cervical cancer.
B. vulvar cancer.
C. endometrial cancer.
D. vaginal cancer.
E. none of the above.
Nr 120. Which of the following tumours should be treated with chemotherapy as a
treatment of choice?
1) cervical cancer;
2) choriocarcinoma;
3) ovarian cancer;
The correct answer is:
A. only 2.
B. 2,3.
4) fallopian tube cancer;
5) vulvar cancer.
C. 3,4.
D. only 4.
E. 4,5.
Nr 121. CIN-2 found in a patient at 24 weeks of gestation makes it necessary to
perform:
A. amputation of the cervix.
B. conization of the cervix.
C. only repeated colposcopic examinations of the cervix until the delivery.
D. treatment with glucocorticosteroids and cesarean section at 28 weeks of gestation.
E. kriotherapy of the cervix.
Nr 122. Problems with coordination, euphoria, anxiety, xerostomia, tachycardia and
the feeling of the slow passage of time – are the signs of the use of:
A. amphetamine.
D. cocaine.
B. Cannabis indica (marihuana).
E. sedatives.
C. opioids.
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Nr 123. Oncological screening is performed for early detection of neoplasms. Only
few screening methods are effective enough. Indicate the effective ones:
A. cervix cancer cytodiagnostics, mammography, colon cancer investigation (occult
blood test and colonoscopy).
B. prostate-specific antigen – PSA (prostate cancer), lung X-ray (lung cancer).
C. gastroscopy (stomach cancer), sputum cytology (lung cancer).
D. per rectum examination (rectal cancer).
E. all the above.
Nr 124. Low height, infertility, skew palpebral fissures, short and fin-shaped neck,
usually normal IQ, often heart defect – are the signs of:
A. Down syndrome (trisomy of chromosome 21).
B. Klinefelter syndrome (karyotype 47XXY).
C. Turner syndrome (monosomy of chromosome X).
D. Edward syndrome (trisomy of chromosome 18).
E. none of the above.
Nr 125. Which of the following considering innocent murmurs is false?
A. usually occur during systole.
B. are soft, less than 3/6 in intensity (according Levine’s scale).
C. increase intensity during cry or anxiety.
D. are often position-dependent.
E. occur only in young children (before school age).
Nr 126. The painful shoulder may be caused by:
1) cervical intervertebral discopathy;
4) cervical rib;
2) shoulder injury;
5) coronary heart disease.
3) syringomyelia or tumor of the cervical spinal cord;
The correct answer is:
A. 1,2.
B. all the above.
C. 2,3,4.
D. 1,5.
E. 1,2,4,5.
Nr 127. Oseltamivir is effective in treating:
A. complications of influenza.
B. protracted influenza.
C. influenza if administered during the first two days of the disease.
D. parainfluenza syndromes.
E. if administered after lowering patient’s body temperature.
Nr 128. Limiting exposure to noise is important for the health of workers because
noise is the most common cause of received ear function damage related to acquired
hearing loss.
A. both statements are true and there is a causal relationship between them.
B. both statements are true but there is no causal relationship between them.
C. the first statement is true but the second is false.
D. the first statement is false and the second is true.
E. both statements are false.
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Nr 129. In streptococcal pharyngitis or tonsilitis, macrolides should be applied only to
patients with immediate-type hypersensitivity to beta-lactams; however, the use of
macrolides in these disorders should be accompanied by the determination of drugresistance to erythromycin.
A. the first statement is true but the second is false.
B. the first statement is false and the second is true.
C. both statements are false.
D. both statements are true but there is no causal relationship between them.
E. both statements are true and there is a causal relationship between them.
Nr 130. Indicate the true statement:
A. routine performing of microbiological tests is recommended to diagnose acute
inflammation of the nasal cavities and paranasal sinuses.
B. performing X-ray examinations is required to diagnose acute inflammation of the
nasal cavities and paranasal sinuses.
C. diagnosis of acute inflammation of the nasal cavities and paranasal sinuses cannot
be made on the basis of medical history and physical examination.
D. duration of the symptoms of acute inflammation of the nasal cavities and paranasal
sinuses over 10 days and deterioration of the clinical status after 5 days are the
most important criteria differentiating viral and bacterial infections.
E. in patients with a moderate course of acute inflammation of the nasal cavities and
paranasal sinuses lasting less than 7-10 days, a course of antibiotics is
recommended.
Nr 131. In order to reduce the spread of infection a patient with streptococcal
pharyngitis or tonsillitis should not be in contact with others at nursery school, school
or work for the period of:
A. 24 hours from the application of an effective antibiotic.
B. 48 hours from the application of an effective antibiotic.
C. 72 hours from the application of an effective antibiotic.
D. 96 hours from the application of an effective antibiotic.
E. 120 hours from the application of an effective antibiotic.
Nr 132. Which of the following is the recommended frequency for performing
glycemia self-control in patients with type 2 diabetes taking oral anti-diabetic drugs or
GLP-1 analogues:
A. once a month an abbreviated glycemic profile.
B. once a week an abbreviated glycemic profile.
C. 1-2 measurements of glycemia daily, in addition once a week an abbreviated
glycemic profile.
D. multiple measurements daily according to established principles.
E. multiple measurements daily according to established principles, and additional
measurements in the case of malaise.
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Nr 133. In patients aged over 45 without clinical symptoms of hyperglycemia and
without risk factors, an examination for diabetes should be performed once per:
A. year.
B. 2 years.
C. 3 years.
D. 4 years.
E. 5 years.
Nr 134. In the treatment of acute bronchitis caused by Bordatella pertussis, antibiotics
should not be used because the application of an antibiotic in whooping cough does
not affect the course of the disease, but only reduces the spread of infection.
A. the first statement is true but the second is false.
B. the first statement is false and the second is true.
C. both statements are false.
D. both statements are true but there is no causal relationship between them.
E. both statements are true and there is a causal relationship between them.
Nr 135. A contraindication to the administration of oral contraceptives in diabetic
women is:
A. unstable diabetes.
B. tobacco smoking.
C. BMI < 30.
D. A and B.
E. A,B,C.
Nr 136. When a women treated for hypothyroidism becomes pregnant it is necessary
to:
A. lower the dose of levothyroxine.
B. increase the dose of levothyroxine.
C. start potassium iodide administration.
D. A and C.
E. B and C.
Nr 137. The increased concentration of D-dimers is observed in:
A. pulmonary embolism.
B. pregnancy.
C. deep vein thrombosis.
D. A and C.
E. A,B,C.
Nr 138. Decreased appetite, pale skin, tearfulness, anal itching at night, teeth
grinding observed in a 3-year-old preschooler suggest:
A. lambliosis.
D. hemorrhoids.
B. atopic dermatitis.
E. food allergy.
C. pinworm infection.
Nr 139. The preventive examination of children at the age of six does not include:
A. height.
B. weight.
C. blood pressure.
D. Hirschberg test (a screening test for strabismus).
E. sexual development according to Tanner scale.
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Nr 140. A medical ruling about pupil’s ability to attend physical education classes that
assigns him to group B states that the pupil:
A. may attend physical education class without limitations.
B. may attend physical education class with limitations and/or requires teacher’s
special attention.
C. should attend corrective gymnastics classes only.
D. may do only selected individual exercises without group exercises.
E. is unable to attend physical education classes.
Nr 141. In a 5-week-old boy fed since his birth with modified milk, spitting up has
been observed for 2 weeks. Lately projectile vomiting with coagulated milk but without
traces of bile has occurred during feeding or just after. In spite of good appetite the
child losses his weight, and anxiety as well as distended epigastrum are observed. The
most probable diagnosis is:
A. cow’s milk protein allergy.
D. cystic fibrosis.
B. milk intolerance.
E. gastroesophageal reflux.
C. pyloric stenosis.
Nr 142. A cognitive impairment clearly associated with stroke is essential for the
diagnosis of:
A. Alzheimer’s disease.
B. Parkinson’s disease.
C. multi-infarct dementia.
D. Huntington’s disease.
E. Pick’s disease.
Nr 143. Which of the following is not part of chronic alcohol-induced psychotic
states?
A. chronic reaction to stress.
B. alcoholic paranoia.
C. chronic alcoholic hallucinosis.
D. alcoholic depression.
E. Korsakow’s psychosis.
Nr 144. Which of the following is not a typical symptom of benzodiazepines
overdose?
A. somnolence.
B. aphasia.
C. apraxia.
D. memory impairment.
E. depression of the respiratory center.
Nr 145. Schizoaffective disorder is diagnosed when in the clinical picture there are
features of schizophrenia and:
A. depression.
B. mania.
C. hypomania.
D. bipolar disorder.
E. subdepression.
Nr 146. The term “paranoia” is currently replaced by the term:
A. schizophrenia.
D. Otello syndrome.
B. delusional disorders.
E. schizoaffective disorder.
C. acute and transient psychotic disorders.
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Nr 147. According to the ICD-10 the diagnosis of mania requires the duration of
symptoms for at least:
A. 3 days.
B. 4 days.
C. one week.
D. 10 days.
E. one month.
Nr 148. Which of the following statements best describes the role of antidepressants
in suicide risk?
A. antidepressants decrease the risk of suicide.
B. antidepressants increase the risk of suicide.
C. the role of antidepressants in suicide risk is not clear.
D. tricyclic antidepressants increase the risk of suicide.
E. the SSRIs decrease the risk of suicide.
Nr 149. Panic attacks are frequent in patients with the following medical conditions,
except:
A. acute pain syndromes.
B. mitral valve prolapse syndrome.
C. anorexia nervosa.
D. adrenal function disturbances.
E. thyroid function disturbances.
Nr 150. The diagnosis of ADHD requires the presence of concentration disturbances,
hyperactivity, and:
A. impulsive behaviour.
B. memory disturbances.
C. low intellectual performance.
D. low body height.
E. eating disorder.
Nr 151. Side effects of antipsychotic drugs: extrapyramidal, hyperprolactinaemia, and
sexual dysfunction are associated with the affinity of those drugs for:
A. adrenergic system.
D. glutamatergic system.
B. GABA-ergic system.
E. dopaminergic system.
C. serotoninergic system.
Nr 152. Which of the following is not a risk factor for extrapyramidal side-effects of
antipsychotic drugs?
A. young age.
B. unstable blood pressure.
C. frequent changes of the doses of antipsychotics.
D. male sex.
E. use of psychoactive substances.
Nr 153. Which of the following antidepressants acts mainly through the noradrenergic
transmission?
A. fluvoxamine.
B. venlafaxine.
C. citalopram.
D. reboxetine.
E. sertraline.
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Nr 154. What is the correct serum lithium level in the prophylactic treatment of bipolar
disorder?
A. 0.5 – 0.8 mmol/l.
B. 0.8 – 1 mmol/l.
C. 1 mmol/l.
D. 1.2 mmol/l.
E. lithium level is not important for therapeutic effects.
Nr 155. Which of the following drugs is primarily used in the pharmacological
treatment of nicotine dependence?
A. buspirone.
D. butyrophenon antipsychotics.
B. bupropion.
E. budesonide.
C. buprenorphine.
Nr 156. Abdominal aortic aneurysm is usually misdiagnosed as:
A. myocardial infarction.
B. nephrolithiasis.
C. pancreatitis.
D. diverculitis.
E. pain in the dorsal muscles.
Nr 157. Which of the following is the most common cause of upper gastrointestinal
bleeding?
A. Mallory-Weiss syndrome.
B. aorto-intestinal fistula.
C. peptic ulcer.
D. arteriovenous malformation.
E. esophageal varices.
Nr 158. Which of the following methods of oxygen supplementation allows the most
exact dosage?
A. nasal tube.
B. standard oxygen mask.
C. mask equipped with an oxygen reservoir and a one-way expiratory valve.
D. Venturi mask.
E. self-inflating bag with a valve and a respiratory mask.
Nr 159. What is the basic element of clinical assessment and treatment in the case of
chemical eye burns?
A. slit-lamp examination to assess the degree of the lesion.
B. repeated eye irrigation with normal saline solution or water upon ER admission.
C. visual acuity test.
D. therapy with antibiotics to limit the risk of secondary infection.
E. pharmacological cycloplegia to increase the aqueous humour flow to the anterior
chamber to lower the pain.
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Nr 160. Which of the following is the primary management in the case of a patient
presenting active aggression?
A. monitoring with pulsoxymeter.
B. immobilisation to protect the patient and people around him.
C. securing the venous access.
D. urine examination for the presence of psychoactive substances.
E. blood glucose examination.
Nr 161. Which of the following cycloplegic agents is the shortest acting one?
A. atropine. B. homatropine. C. pilocarpine. D. cyclopentolate.
E. tropicamide.
Nr 162. A 60-year-old male suffering from crushing chest pain for 2 hours reaches the
Emergency Room (ER) and suddenly collapses. ECG as follows. The diagnosis and
the first line treatment would be:
A. ventricular tachycardia & cardioversion.
B. ventricular fibrillation & defibrillation.
C. atrial flutter & amiodarone.
D. atrial fibrillation & cardioversion.
E. normal sinus rhythm & no treatment required.
Nr 163. The major clinical signs of tension pneumothorax include:
1) respiratory distress;
2) tracheal deviation;
3) neck vein distension;
4) decreased breath sounds and hyperresonance ipsilateral to the injury.
The correct answer is:
A. 1,2,3.
B. 1,2.
C. 1,2,4.
D. 2,3,4.
E. all the above.
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Nr 164. The initial treatment of tension pneumothorax includes:
A. needle thoracostomy, usually a 14-gauge IV catheter at the midclavicular line in the
second intercostal space.
B. chest drain at the anterior axillary line in the third intercostal space.
C. endotracheal intubation and mechanical ventilation.
D. emergency thoracotomy.
E. oxygen therapy.
Nr 165. Which part of the heart is most commonly injured in blunt myocardial contusion?
A. left ventricle.
B. left atrium.
C. aorta.
D. pulmonary artery.
E. right ventricle.
Nr 166. The most common cause of SCA (sudden cardiac arrest) in adults is:
A. asystole.
B. ventricular fibrillation.
C. PEA (Pulseless Electrical Activity).
D. tachycardia.
E. cardiac tamponade.
Nr 167. MONA treatment is essential in:
A. DVT (deep venous thrombosis).
B. myocardial infarction.
C. pneumonia.
D. hypovolemic shock.
E. hypoglycemia.
Nr 168. Magnesium sulphate is the drug of choice in:
A. asystole.
B. ventricular fibrillation.
C. bradycardia.
D. Torsades de pointes.
E. atrial fibrillation.
Nr 169. A 75-year-old male presents to the Emergency Room (ER) with the laceration
over his left eye after sustaining a head injury without any loss of consciousness. His
past medical history states that he suffers from atrial fibrillation and takes anticoagulants. His GCS is 15 with irregular HR of 75-80 beats/min and normal BP.
The best care in ER would be:
A. consult a neurosurgeon at first.
B. 24 hours ER observation and discharge.
C. perform the CT scan during observation in ER.
D. treat the wound and send the patient home.
E. admission to a cardiology ward.
Nr 170. A 27-year-old female presents to the Emergency Room (ER) with a RLQ
(right lower quadrant) abdominal pain. On exam – acute tenderness at RLQ, HR –
140/min, BP – 110/70. The right initial diagnosis:
A. appendicitis or extrauterine pregnancy. D. renal colic only.
B. biliary or renal colic.
E. extrauterine pregnancy or renal colic.
C. pancreatitis or gastroenterocolitis.
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Nr 171. The most common side effect of placing a central venous catheter in the
jugular vein is:
A. pneumothorax.
B. jugular artery puncture.
C. hematoma of the neck.
D. severe pain.
E. dysphagia.
Nr 172. The 2010 ERC Adult CPR guidelines regarding manual chest compressions
state as follows:
A. 80-100 chest compressions/min with the depth of 4-5 cm.
B. 80-100 chest compressions /min with the depth of 1/3 of the chest.
C. 80-100 chest compressions/min with the depth of at least 5 cm.
D. at least 100 chest compressions/min with the depth of at least 5 cm.
E. at least 100 chest compressions /min with the depth of 1/3 of the chest.
Nr 173. The surface area of a burn injury can be estimated with the use of:
A. rule of 18.
B. Wallace’s rule of 9.
C. hand rule.
D. creatinine excretion.
E. serum albumin concentration.
Nr 174. While transporting on a backboard a pregnant woman after trauma, the
following should be observed?
A. 15 degree tilt to the left.
B. 15 degree tilt to the right.
C. 45 degree tilt to the left.
D. 45 degree tilt to the right.
E. exact horizontal position.
Nr 175. The treatment of choice of atrial fibrillation lasting more than 48 hours is:
A. cardioversion in the Emergency Room upon presence.
B. amiodarone 300 mg bolus i.v.
C. bretylium 5 mg i.v.
D. delayed cardioversion with anticoagulants prescribed to attain therapeutic INR
range.
E. cardioversion after a bolus of amiodarone (300 mg i.v.).
Nr 176. According to the Polish Code of Medical Ethics are donors of cells, tissues or
organs for transplantation allowed to get paid for their cells, tissues or organs?
A. yes.
D. no.
B. yes, but only for organs.
E. possible payment depends on
C. there is no relevant provision in the Code.
the donor’s decision.
Nr 177. According to the Polish Code of Medical Ethics is medical secrecy absolute,
or does the Code provide for exceptions to this principle?
A. it is absolute secrecy.
B. Code provides derogations from medical secrecy.
C. there is no relevant provision in the Code.
D. Code refers to the relevant legislation.
E. relevant provision applies only to surgeons.
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Nr 178. What form of consent for getting cells, tissues or organs from corpses does
the Polish Code of Medical Ethics allow?
A. consent of the family of the deceased.
B. lawyer’s permission.
C. doctor's permission.
D. informed consent.
E. implied consent.
Nr 179. Proceedings at a medical court were instituted against a physician. The
defendant doctor may be assisted by counsel. This may be:
1) another physician;
2) any designated agent;
3) professional liability screener of the regional chamber of physicians and
dentists, a chamber before which the proceedings are taking place;
4) solicitor;
5) judge ruling on criminal matters.
The correct answer is:
A. only 2.
B. 1,3.
C. 4,5.
D. 1,4.
E. 3,5.
Nr 180. The formal bodies of a regional chamber of physicians and dentists are,
among others:
1) regional medical assembly;
2) regional doctors’ ombudsman;
3) regional patients’ ombudsman;
The correct answer is:
A. 2,4.
B. 1,4.
C. 1,5.
4) regional medical council;
5) regional agent for the postgraduate
education of physicians and dentists.
D. 2,3.
E. 2,5.
Nr 181. A doctor has a duty:
A. to keep medical secrecy until patient's death.
B. to keep medical secrecy also after patient's death.
C. to disclose medical information concerning patients playing important social roles.
D. to disclose medical information concerning patients who are public officials.
E. to disclose medical information concerning patients who are minors.
Nr 182. In the event of the death of a patient from injury or poisoning the medical
records must be kept:
A. for 10 years from the last entry.
B. for 30 years from the end of the year in which the death occurred.
C. for a period specified by the judicial authorities (in each case individually).
D. as decided by the manager of a health care institution.
E. there is no such legal regulation.
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Nr 183. A person can be involuntarily hospitalized in a psychiatric ward only when:
A. such a need is being reported by the patient's family members.
B. such a need is seen by his family physician.
C. his behavior indicates that due to his illness he directly threatens his own life or
health and the lives of other people.
D. police recommend it.
E. law does not regulate compulsory psychiatric hospitalization.
Nr 184. Which of the following bodies sets and takes care of universally binding all
doctors principles of medical ethics (including professional liability)?
A. Government.
D. Physician Self-Government.
B. Parliament.
E. patients association.
C. Minister of Health.
Nr 185. In particularly justified cases, a doctor may refuse to treat or to continue
treating the patient. However, he cannot do this:
A. if the patient is in hospital.
B. in urgent cases where there is a threat to the patient's life.
C. if the service has already been paid.
D. when he received the order from his superior.
E. when the patient has not chance to receive another doctor’s assistance
immediately.
Nr 186. In old age and disability insurance for farmers one of the condition for
granting a pension is the decision of:
A. degree of disability.
B. partial incapacity for work.
C. 50% of damage to health resulted from an accident on the farm.
D. total incapacity to work on a farm.
E. inability to live independently.
Nr 187. How many medical statements ZUS, ZLA should be issued to an insured
person who is employed by four employers?
A. one.
B. two.
C. three.
D. four.
E. five.
Nr 188. Social Insurance Fund (ZUS) authorizes doctors to issue medical rulings on
temporary incapacity to work for the period of:
A. 3 months.
B. 1 year.
C. 2 years.
D. 3 years.
E. indefinitely.
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Nr 189. Agricultural Social Insurance (KRUS) expert doctors and its medical boards
do not give a ruling on:
A. total incapacity for work on a farm.
B. temporary incapacity for work, an incapacity lasting longer than 180 days.
C. inability to live independently.
D. degree of disability.
E. desirability of professional retraining resulting from total incapacity for work on a
farm.
Nr 190. Social pension is not granted to an adult who is totally incapable to work due
to violation of the efficiency of the body, which arose:
A. before the age of 18.
B. during school or college before the age of 25.
C. during doctoral studies.
D. during studies for fellowship in science.
E. in the course of employment.
Nr 191. Which of the following serves as a basis to issue a medical statement on
temporary incapacity to work due to illness (ZUS ZLA)?
A. written request from a medical specialist.
B. certificate of the residence of the insured person in hospital.
C. direct medical examination of the insured person.
D. certificate of medical assistance from emergency ambulance service.
E. certificate of medical assistance from the emergency department.
Nr 192. Who is authorized to issue medical statements on temporary incapacity to
work for the earlier period than 3 days prior to the medical examination day of the
insured person?
A. SIF (ZUS) certifying doctor.
B. ASIF (KRUS) certifying doctor.
C. attending doctor after obtaining approval from the President of SIF(ZUS).
D. psychiatrist.
E. hospital administrator.
Nr 193. Which of the following factors are most useful for characterizing the health
status of the population?
1) average life span;
2) newborn mortality rate;
3) number of hospital beds per 10000 inhabitants;
4) number of nurses per 10000 inhabitants;
5) cardiovascular disease standardized mortality ratio.
The correct answer is:
A. 1,2,5.
B. 1,2,3.
C. 1,2,3,5.
D. 1,3,4,5.
E. all the above.
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Nr 194. Which of the following statements concerning average life expectancy in
Poland is true?
A. longest life expectancy is among inhabitants of Lodz and Silesia cities.
B. life expectancy in rural areas is about 3-5 years longer than in big cities.
C. average life expectancy in Poland has nothing in common with the education.
D. women in Poland live on average 3-5 years longer than men.
E. all the above are false.
Nr 195. Which of the following information illustrating a number of adult Poles with
chronic diseases or risk factors in the first decade of 21st century is false?
A. smoking - about 9 mln inhabitants.
B. diabetes - about 1.5-2.0 mln inhabitants.
C. hypercholesterolemia - about 17 mln inhabitants.
D. hypertension - about 2 mln inhabitants.
E. all the above are true.
Nr 196. Which of the following reasons are responsible for premature mortality in
Poland?
1) coronary heart disease;
2) congenital cardiac defects;
3) cancers;
The correct answer is:
A. 1,3,5.
B. 1,2,5.
C. 1,4,5.
4) traffic accidents and injuries;
5) infectious diseases.
D. 1,3,4.
E. 2,3,4.
Nr 197. Which of the following documents indicates the particular role of primary
healthcare in the operation of the entire healthcare system?
A. Declaration of WHO International Conference in Alma-Ata in 1978.
B. Ottawa Charter for Health Promotion of 1986.
C. Amsterdam Treaty of 1997.
D. World Health Declaration of 1998.
E. none of the above.
Nr 198. Which of the following disease risk factors are related to lifestyle?
1) low physical activity;
2) nutritional habits;
3) polluted water;
4) alcohol abuse;
The correct answer is:
A. 1,3.
B. 2,4,6.
C. 1,2,3,4.
5) nicotine addiction;
6) occupational risk factors;
7) use of psychoactive agents.
D. 1,2,4,5,7.
E. 2,3,4,5,6.
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Nr 199. According to the Law on the health care financed from public resources which
of the following services are available without referral?
A. specialist consultations.
B. primary health care (family doctor consultation).
C. medical rehabilitation.
D. diagnostic examinations.
E. A and D.
Nr 200. The current National Health Programme (NHP):
A. specifies the aims of national health policy.
B. covers years 2007-2015.
C. distinguishes strategic and operational aims.
D. aims to improve public health.
E. all of the above.
Thank you!